Chemotherapy Improves Survival of AIDS-related Lymphoma Patients, Study Finds

Patients with AIDS-related lymphoma have better survival outcomes when standard chemotherapy is added to their combined antiretroviral therapy (cART), a new study shows.

The study, “The clinical features and prognosis of 100 AIDS-related lymphoma cases,” was published in Scientific Reports.

Human immunodeficiency virus (HIV) infection is known to increase the risk of cancer. In fact, nearly one-third of HIV-related deaths are attributed to malignant tumors, and one in four HIV-infected people eventually become diagnosed with a type of cancer known as acquired immunodeficiency syndrome (AIDS)-related lymphoma.

AIDS-related lymphoma (ARL) is a fast-growing and invasive cancer. If left untreated, it can cause death within months or even weeks after diagnosis.

The introduction of combined antiretroviral therapy (cART) has led to a significant reduction in the incidence of ARL and AIDS-related deaths.

Early studies of ARL have reported several risk factors that are thought to be associated with poor prognosis. These factors include patient age and performance status, history of AIDS, low CD4  count (immune cells that are involved in AIDS), and lymphoma-specific factors such as stage of cancer, lactate dehydrogenase levels (a compound involved in initiation and growth of cancer), extranodal disease (cancer that has spread), and a high international prognostic index (IPI, criteria for measuring prognosis).

In China, HIV-infected patients have traditionally been excluded from participating in clinical trials due to poor prognosis or adherence to treatment. Consequently, there are no HIV-specific guidelines for the management of ARL patients. Furthermore, it remains unclear which prognostic factors are related to the prognosis of ARL in Chinese patients.

Therefore, researchers conducted a retrospective study to analyze the clinical features and outcomes of chemotherapy plus cART in 100 ARL patients, who were diagnosed at the Henan Provincial Infectious Disease Hospital in China. They also assessed different factors that could affect prognosis.

The researchers undertook this study to provide information that would help facilitate the establishment of guidelines for management of these patients.

First, the researchers determined the time patients lived without signs of disease progression — a measure called progression-free survival (PFS) — and the two-year overall survival (OS) rate of all patients. Next, they determined the correlation of PFS and OS with numerous variables.

Results indicated that PFS and two-year OS rates were significantly higher in patients that were administered chemotherapy in addition to cART compared with patients given cART alone.

However, PFS and OS rates did not differ significantly between patients who received chemotherapy before receiving cART compared with patients who received chemotherapy at the same time as cART.

The researchers also evaluated the effect of other factors and found that younger age, high age-adjusted IPI (aaIPI), elevated levels of lactate dehydrogenase, and the subtype of Burkitt/Burkitt-like (BL/BLL) lymphoma were all predictors of poorer overall survival at two years.

Other factors, such as gender, Ann Arbor stage (stage of cancer), primary site, and baseline CD4  count were not associated with prognosis.

Overall, “we have shown that ARL patients had better survival outcomes when treated with standard-dose chemotherapy plus cART, compared to cART alone,” the researchers wrote.

“A high aaIPI, elevated LDH [lactate dehydrogenase] level, BL/BLL pathological subtype, age <45 years, and non-chemotherapy were indicators of poor prognosis,” they concluded.